Reproductive Rights

Reproductive rights—having the ability to decide whether and when to have children—are important to women’s socioeconomic well-being and overall health. Research suggests that being able to make decisions about one’s own reproductive life and the timing of one’s entry into parenthood is associated with greater relationship stability and satisfaction (National Campaign to Prevent Teen and Unplanned Pregnancy 2008), more work experience among women (Buckles 2008), and increased wages and average career earnings (Miller 2011). In recent years, policies affecting women’s reproductive rights in the United States have substantially changed at both the federal and state levels. Between the publication of the 2004 Status of Women in the States report and this report, states overall made nominal progress on two indicators and declined or stayed the same on five others.

Yes

No

Mixed

Percent

Number of States Requiring Parental Consent and/or Notification for Abortion Services for Minors

43

8

Number of States Mandating a Waiting Period Prior to Abortion Services

30

21

Number of States Providing Public Funding for Abortions

17

34

Percent of Women Living in Counties with an Abortion Provider

34%

Number of States with a Pro-Choice Governor and Legislature

6

21

24

Number of States That Have Adopted Medicaid Expansion or with Expanded Eligiblity for Medicaid Family Planning Services

43

8

Number of States Requiring Health Insurers to Provide Coverage of Infertility Treatments

14

37

Number of States Allowing Same-Sex Marriage or Second-Parent Adoption

38

9

4

Number of States Requiring Schools to Provide Sex Education

23

28

Note: See methodology for details and sources.

Compiled by the Institute for Women’s Policy Research.

Access to Abortion

In the United States, the 1973 Supreme Court case Roe v. Wade established the legal right to abortion. State legislative and executive bodies nonetheless continue to battle over legislation related to access to abortion, including parental consent and notification and mandatory waiting periods (Guttmacher Institute 2015b). In addition, public funding for abortion remains a contested issue in many states: federal law has banned the use of federal funds for most abortions since 1977, and currently does not allow the use of federal funds for abortion unless the pregnancy resulted from rape or incest or the woman’s life is in danger (Boonstra 2013). The Affordable Care Act of 2010 reinforces these restrictions, but state Medicaid programs have the option to cover abortion in other circumstances using only state and no federal funds (Salganicoff et al. 2014).

State legislative efforts to limit access to abortion have become commonplace. In 2013 and 2014, a broad range of legislation was introduced and passed, including bills requiring women to have an ultrasound before obtaining an abortion, stringent regulatory measures targeting abortion providers, bans or restrictions preventing women from obtaining health insurance coverage for abortion, and bans on abortion at later stages of pregnancy (National Women’s Law Center 2014a and 2014b).

The Affordable Care Act and Contraceptive Coverage

The 2010 Patient Protection and Affordable Care Act (ACA) has expanded women’s access to contraception in several ways, including by requiring health care insurers to cover contraceptive counseling and services and all FDA-approved contraceptive methods without any out-of-pocket costs to patients (U.S. Department of Health and Human Services 2014). This change is particularly significant for lower-income women who often struggle with the financial burden associated with purchasing contraception on a regular basis (Center for Reproductive Rights 2012). According to the Guttmacher Institute, the average cost of a year’s supply of birth control pills is the equivalent of 51 hours of work for a woman making the federal minimum wage of $7.25 an hour (Sonfield 2014). One national study estimates that for uninsured women, the average cost of these pills over a year ($370) is 68 percent of their annual out-of-pocket expenditures for health care services (Liang, Grossman, and Phillips 2011).

Medicaid Expansion and State Medicaid Family Planning Eligibility Expansions

In addition to requiring most health insurers to cover contraceptive counseling and services and all FDA-approved contraceptive methods, the Affordable Care Act has increased women’s access to contraception by expanding the number of people who have health insurance coverage. The ACA has dramatically reduced rates of uninsurance among women aged 18 to 24 by allowing adult children to stay on their parents’ health insurance plans until the age of 26; between 2008 and 2014, the percentage of women aged 18 to 24 without health insurance decreased from 24.9 to 15.9 percent. During this time period, uninsurance rates for women of all ages dropped about 18 percent, from 13.0 percent of women lacking insurance in 2008 to 10.6 percent in the first nine months of 2014 (Martinez and Cohen 2009 and 2015). Complete data reflecting changes in health insurance for women following the ACA are not yet available.

Other Family Planning Policies and Resources

Infertility treatments can increase the reproductive choices of women and men, but they are often prohibitively expensive, especially when they are not covered by insurance. As of June 2014, the legislatures of 12 states—Arkansas, Connecticut, Hawaii, Illinois, Maryland, Massachusetts, Montana, New Jersey, New York, Ohio, Rhode Island, and West Virginia—had passed measures requiring insurance companies to cover infertility treatments.

Fertility, Natality, and Infant Health

The fertility rate for women in the United States has declined in recent years, due in part to women’s tendency to marry and give birth later in life. In 2013, the median age for women at the time of their first marriage was 26.6 years, up from 20.3 years in 1960 (U.S. Census Bureau 2013; Cohn et al. 2011). In 2013, the mean age for women at the time of their first birth was 26.0 years, compared with 21.4 years in 1970 (Martin et al. 2015a; Mathews and Brady 2009).

Prenatal Care, Infant Mortality, and Low Birth Weight in the United States, by Race and Ethnicity, United States

Percent of Mothers Beginning Prenatal Care in the First Trimester of Pregnancy

All Women

83.6%

White

85.7%

Hispanic

82.6%

Black

80.9%

Asian/Pacific Islander

83.9%

Native American

81.0%

Infant Mortality Rate (deaths of infants under age one per 1,000 live births)

All Women

6.0

White

5.0

Hispanic

5.1

Black

11.2

Asian/Pacific Islander

4.1

Native American

8.4

Percent of Low Birth-Weight Babies (less than 5 lbs., 8 oz.)

All Women

8.0%

White

7.0%

Hispanic

7.1%

Black

13.1%

Asian/Pacific Islander

8.3%

Native American

7.5%

Notes: Data on prenatal care are for 2011. Data on infant mortality are for 2012. Data on the percent of low birth-weight babies are for 2013. For data on prenatal care and low birth-weight, whites and blacks are non-Hispanic; other racial groups include Hispanics. For data on infant mortality, all racial categories are non-Hispanic. Hispanics may be of any race or two or more races.

Source: IWPR compilation of data from the Centers for Disease Control and Prevention 2012 and 2013 and from Hamilton et al. 2014.

View Additional Data by State

See the state-level data is available on low birth weight babies and infant mortality rates by race and ethnicity.